The total fertility rate in the United States -- the number of children born per woman -- has dropped by nearly half since the 1950s to 1.88. Historically, declines in total fertility rates have been seen during times of economic hardship, such as the Great Depression and the 1970s energy crisis. Accordingly, increases were seen in more plentiful eras like the 1950s and 1960s -- out of which came the baby boomer generation. Fluctuations have been less dramatic in recent decades, but geographical differences still exist. That got us thinking: Which states are the most fertile -- and how might the expense of having children and changes in health policy affect women's decision to have children?

The most fertile states in the nation
Do you live in one of the most fertile states? We used the Centers for Disease Control's total fertility rates to determine the most fertile parts of the United States:

1. Utah: 2.374 children born per woman
2. South Dakota: 2.269
3. Idaho: 2.193
4. Alaska: 2.185
5. North Dakota: 2.122
6. Nebraska: 2.119
7. Kansas: 2.118
8. Hawaii: 2.095
9. Texas: 2.075
10. Oklahoma: 2.039

The least fertile states in the nation
Is your home state resistant to multiple children? These are the states (inclusive of the District of Columbia) with the lowest total fertility rates:

1. Rhode Island: 1.593 children born per woman
2. New Hampshire: 1.605
3. D.C.: 1.608
4. Vermont: 1.613
5. Massachusetts: 1.632
6. Connecticut: 1.665
7. Maine: 1.678
8. Oregon: 1.742
9. Florida: 1.769
10. New York: 1.773

The impact of cost
Children are not cheap. One study found that women in California face hospital bills for childbirth ranging from $3,296 to $37,227, and nationwide, out-of-pocket costs for the insured average $3,400. New costs arise virtually every week of pregnancy. A home birth can be some 60% less expensive, but there are other considerations with opting for a home birth. And these bills cover just the pregnancy and birth -- not the diapers, formula, food, and other immediate costs, nor long-term expenses such as your child's education. And then there are the unexpected costs of having a baby.

The CDC recently reported that birth rates for teenagers and those in their early 20s are at record lows, and the birth rate for those between ages 25 and 29 also declined. Older mothers, those between ages 30 and 44 and who might be in a more secure financial state, make up the only group whose birth rates increased. The Population Reference Bureau indicates this may be due to the recent recession but also points out that long-term trends in fertility may be linked to women's employment and earnings, compared with men.

The impact of health policy
Healthcare itself has changed greatly in the past few years. The Affordable Care Act provides many women's health benefits: Contraception, maternity care, breastfeeding services, and well-woman visits are covered, some free of charge. Whereas many pre-health-reform plans did not cover pregnancy and therefore left women with the entire bill, plans are now required to cover pregnancy -- which means that many more women will be able to have a baby affordably. This will give expectant mothers the chance to ask the right questions before deciding on an OB/GYN and choosing a hospital for giving birth.

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